Subclinical left ventricular diastolic dysfunction in adults with overweight or obesity and preserved ejection fraction.

BACKGROUND

Excess adiposity exerts haemodynamic, metabolic, and inflammatory effects on the myocardium that can produce left ventricular diastolic dysfunction (LVDD) before systolic function is impaired. South Asian adults are susceptible at lower body mass index (BMI) thresholds, yet evidence on subclinical LVDD in otherwise healthy adults with overweight or obesity is limited.

METHODS

Tertiary care hospital-based, cross-sectional study (June 2024-February 2026). 72 adults were enrolled aged 18-65 years with BMI ≥23 kg/m2 (Asian cut-offs) and preserved left ventricular ejection fraction (LVEF) > 50%, with no previously diagnosed cardiovascular disease or other established causes of diastolic dysfunction after excluding hypertension, diabetes, coronary, valvular, renal, thyroid, and pulmonary disease, sleep apnoea, smoking, and alcohol use. All underwent 2D transthoracic echocardiography classified per 2016 ASE/EACVI recommendations.

RESULTS

Grade I LVDD was present in 29/72 participants (40.3%); none had grade 2 or grade 3 dysfunction. Affected adults were older (between 51 and 60 years of age) with higher HbA1c (5.52 vs 5.27%), LDL cholesterol (138.2 vs 110.9 mg/dL), and total cholesterol (205.9 vs 173.9 mg/dL). Mean BMI did not differ (27.9 vs 28.9 kg/m2), although BMI ≥25 kg/m2 as a binary indicator was associated with LVDD. E/A (0.76 vs 1.33) and septal e' (0.09 vs 0.11 m/s) were reduced; E/e' trended higher (8.29 vs 7.61). LVEF was preserved (∼64.7%) in both groups. No safety events occurred.

CONCLUSION

Grade I left ventricular diastolic dysfunction was identified in 40.3% of adults with overweight or obesity and preserved systolic function who had no previously diagnosed cardiovascular disease or other established causes of diastolic dysfunction. Older age, higher HbA1c, and adverse lipid profiles were associated with LVDD, whereas BMI as a continuous variable was not. These findings suggest that subclinical diastolic abnormalities may be common in this population and support the need for prospective studies to determine their long-term clinical significance and relationship to future cardiovascular outcomes.